Oskretkov V I, Gur'yanov A A, Gankov V A, Klimova G I, Andreasyan A R, Balatsky D V, Fedorov V V, Maslikova S A
Altai State Medical University of Health Ministry of the Russian Federation, Barnaul, Russia.
Khirurgiia (Mosk). 2016(6):47-51. doi: 10.17116/hirurgia2016647-51.
To analyze the results of endoscopic interventions for benign diseases and injuries of the esophagus.
159 patients with benign diseases and perforation of the esophagus were operated. There were 72 (45.3%) cases of achalasia, 56 (35.2%) with post-ambustial stenosis of esophagus, 14 (8.8%) with esophageal perforation, 13 (8.2%) with leuomyoma of esophagus and 4 (2.5%) with diverticulum of thoracic esophagus.
In long-term period 56 patients with achalasia were followed-up after laparoscopic Heller cardiomyotomy with Dor fundoplication. Good results were observed in all cases. Three patients died in early postoperative period after thoracoscopic extirpation of esophagus with esophagoplasty via laparotomy at the stage of development of the technique. There were no deaths after thoracoscopic extirpation of esophagus with simultaneous laparoscopic gastroplasty. Postoperative period was significantly less after thoracoscopic extirpation of esophagus with simultaneous laparoscopic esophagogastroplasty using whole stomach compared with esophagogastroplasty and esophagocoloplasty via laparotomy. In long-term postoperative period different complications occurred in 17 cases. Two patients with esophageal perforation died after video-assisted laparotranshiatal drainage of posterior mediastinum. Scarring of esophageal defect was observed in others. Seam failure after esophageal leuomyoma removal was diagnosed in 2 patients that required video-assisted laparotranshiatal drainage of posterior mediastinum and Maydl jejunostomy. Seam failure in thoracic esophagus after thoracoscopic removal of diverticulum was observed in 1 case. The complication was cured by video-assisted laparotranshiatal drainage of posterior mediastinum.
分析食管良性疾病及损伤的内镜干预结果。
对159例食管良性疾病及穿孔患者进行手术。其中贲门失弛缓症72例（45.3%），食管烧伤后狭窄56例（35.2%），食管穿孔14例（8.8%），食管平滑肌瘤13例（8.2%），胸段食管憩室4例（2.5%）。
对56例贲门失弛缓症患者行腹腔镜Heller贲门肌切开术加Dor胃底折叠术，并进行长期随访，所有病例效果良好。在技术发展阶段，3例患者在经胸腔镜食管切除并经剖腹手术行食管成形术的术后早期死亡。同期行腹腔镜胃成形术的胸腔镜食管切除术后无死亡病例。与经剖腹手术行食管胃成形术及食管结肠成形术相比，采用全胃同期行腹腔镜食管胃成形术的胸腔镜食管切除术后，术后恢复时间明显缩短。术后长期有17例出现不同并发症。2例食管穿孔患者在电视辅助经腹后纵隔引流术后死亡，其他患者出现食管缺损瘢痕形成。2例食管平滑肌瘤切除术后诊断为吻合口漏，需行电视辅助经腹后纵隔引流及Maydl空肠造口术。1例胸腔镜下切除胸段食管憩室后出现吻合口漏，经电视辅助经腹后纵隔引流治愈。
